Michigan's two largest health information exchanges, Michigan Health Connect, Grand Rapids, and the Great Lakes Health Information Exchange, East Lansing, have agreed to merge.

The two HIEs, both founded in 2009, had entered into a data exchange agreement in October 2013 before taking the plunge to unite.

Michigan Health Connect claims 83 hospitals and more than 17,000 individual healthcare providers are connected to its system, while GLHIE claims 16 hospitals and 61 participating provider organizations, according to their websites.

The merger comes at a likely inflection point in the more than two-decade history of health information exchanges, whose fortunes received a financial boost in 2009 with passage of the American Recovery and Reinvestment Act. The stimulus law provided $548 million in federal grants to states, territories and the District of Columbia to set up and sustain HIEs. It's still unclear whether many HIEs will survive without federal or state subsidies.

In a 2013 survey of almost 200 of the 315 HIEs nationally, 51 organizations “indicated that they received sufficient revenue from participating entities to cover operating expenses, while 51 have not,” according to the eHealth Initiative, a Washington, D.C.-based not-for-profit organization that promotes the use of health information technology.

The merger comes at a likely inflection point in the more than two-decade history of health information exchanges, whose fortunes received a financial boost in 2009 with passage of the American Recovery and Reinvestment Act. The stimulus law provided $548 million in federal grants to states, territories and the District of Columbia to set up and sustain HIEs. It's still unclear whether many HIEs will survive without federal or state subsidies.

In a 2013 survey of almost 200 of the 315 HIEs nationally, 51 organizations “indicated that they received sufficient revenue from participating entities to cover operating expenses, while 51 have not,” according to the eHealth Initiative, a Washington, D.C.-based not-for-profit organization that promotes the use of health information technology.